Working...
ClinicalTrials.gov
ClinicalTrials.gov Menu

IRX-2, and Pembrolizumab in Treating Participants With Recurrent or Metastatic Gastric or Gastroesophageal Junction Cancer

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
ClinicalTrials.gov Identifier: NCT03918499
Recruitment Status : Recruiting
First Posted : April 17, 2019
Last Update Posted : May 15, 2019
Sponsor:
Collaborator:
National Cancer Institute (NCI)
Information provided by (Responsible Party):
City of Hope Medical Center

Brief Summary:
This phase Ib/II trial studies the side effects of IRX-2, cyclophosphamide, and pembrolizumab work in treating participants with gastric or gastroesophageal junction cancer that has come back or that has spread to other places in the body. Interleukins, such as those found in IRX-2, are proteins made by white blood cells and other cells in the body and may help regulate immune response. Drugs used in chemotherapy, such as cyclophosphamide, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Monoclonal antibodies, such as pembrolizumab, interfere with the ability of tumor cells to grow and spread. Giving RX-2, cyclophosphamide, and pembrolizumab may work better in treating participants with gastric or gastroesophageal junction cancer.

Condition or disease Intervention/treatment Phase
Stage IV Gastric Adenocarcinoma Stage IV Gastroesophageal Junction Adenocarcinoma Drug: IRX-2 Biological: Pembrolizumab Phase 1 Phase 2

Detailed Description:

PRIMARY OBJECTIVES:

I. To determine the safety profile of combination IRX-2 regimen and pembrolizumab.

SECONDARY OBJECTIVES:

I. To evaluate the overall response rate of IRX-2 regimen combined with pembrolizumab using Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 and immune modified RECIST criteria.

II. To evaluate initial median progression-free and overall survival in these patients treated with combination IRX-2 regimen and pembrolizumab.

EXPLORATORY OBJECTIVES:

I. To evaluate the circulating T cell profiles in patients before and after therapy with combination IRX-2 regimen and pembrolizumab.

II. To evaluate the baseline and post-treatment tumor tissue immune gene expression profiling using the Nanostring platform.

III. To explore identification of tumor tissue neoantigens through a multiplex proteomic assay (MHC-PepSeq) paired with tumor genomic and transcriptomic sequencing.

IV. To explore putative biomarkers (including circulating tumor deoxyribonucleic acid [DNA] and immune cell profiles) in peripheral blood to generate hypotheses for response to treatment with combination IRX-2 regimen and pembrolizumab.

OUTLINE:

Participants receive pembrolizumab intravenously (IV) over 30 minutes on day 1. Participants also receive cyclophosphamide IV on day 1 and IRX-2 subcutaneously (SC) on for 10 days starting on day 4 during courses 1, 5, 9, 13, 17, 21, 25, 29, and 33. Treatment repeats every 3 weeks for up to 35 courses in the absence of disease or unacceptable toxicity.

After completion of study treatment, participants are followed up for 30 days and then up to 1 year.


Layout table for study information
Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 20 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase 1b/2 Trial of the IRX-2 Regimen and Pembrolizumab in Patients With Advanced Gastric and Gastroesophageal Junction (GEJ) Adenocarcinoma
Actual Study Start Date : April 18, 2019
Estimated Primary Completion Date : June 24, 2021
Estimated Study Completion Date : June 24, 2021

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: IRX-2 Regimen combined with Pembrolizumab
IRX-2 Regimen (2 mL - Dose level 1, 4 mL - Dose level 2) combined with Pembrolizumab (200 mg)
Drug: IRX-2
IRX-Regimen: 21 day regimen of cyclophosphamide on Day 1 and subcutaneous IRX-2 injections for 10 days between Days 4 and 15. This 21 day regimen will be given every 12 weeks

Biological: Pembrolizumab
Pembrolizumab 200 mg will be given via IV infusion once every 21 days
Other Names:
  • Keytruda
  • Lambrolizumab
  • MK-3475
  • SCH 900475




Primary Outcome Measures :
  1. Number of participants with dose-limiting toxicities as assessed by CTCAE v5.0 [ Time Frame: Up to 30 days after last dose ]

Secondary Outcome Measures :
  1. Progression-free survival assessed by Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 criteria and immune related (ir)RECIST [ Time Frame: From first day of study drug administration to disease progression or death, assessed up to 2 years ]
    Kaplan-Meier estimates and corresponding 95% confidence intervals for the median and quartiles will be provided.

  2. Overall survival assessed by RECIST 1.1 criteria and irRECIST [ Time Frame: Up to 2 years ]
  3. Overall response rate assessed by RECIST 1.1 criteria and irRECIST [ Time Frame: Up to 2 years ]

Other Outcome Measures:
  1. Circulating T cell profiles for each participant with the combination of IRX-2 regimen and pembrolizumab [ Time Frame: At pre- and post-intervention assessed up to 2 years ]
    Will be compiled using descriptive statistics. Data will be screened for parametric statistical assumption and the alpha level for all statistical tests will be set at .05. The Bonferroni correction will be applied to adjust for potentially inflated family wise error rates for multiple comparisons with the same sample.

  2. Difference in tumor tissue Nanostring expression profiling [ Time Frame: From baseline to post-treatment assessed up to 2 years ]
    Will conduct repeated measures t-tests. Data will be screened for parametric statistical assumption and the alpha level for all statistical tests will be set at .05. The Bonferroni correction will be applied to adjust for potentially inflated family wise error rates for multiple comparisons with the same sample.

  3. Identification of tumor neoantigens using multiplex proteomic assay (MCH-PepSeq) assay [ Time Frame: Up to 2 years ]
  4. Circulating tumor deoxyribonucleic acid (DNA) detection from peripheral blood as an exploratory pharmacodynamic biomarker of response [ Time Frame: Up to 2 years ]


Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


Layout table for eligibility information
Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patients with histologically or cytologically confirmed recurrent or metastatic gastric or gastroesophageal junction (GEJ) adenocarcinoma progressed or intolerant to >= 2 lines of systemic therapy.
  • Patients must have recurrent or metastatic gastric/GEJ adenocarcinoma that are not amenable to local therapy with curative intent (surgery or radiation therapy with or without chemotherapy).
  • Willing and able to give informed consent and adhere to protocol therapy; written informed consent and any locally required authorization must be obtained from the patient prior to performing any protocol-related procedures, including screening evaluations.
  • No prior exposure to PD-1/PD-L 1 inhibitor therapy.
  • Patients are deemed eligible for pembrolizumab therapy with tumors demonstrating PD-L1 expression by the Combined Positive Score (CPS) being >= 1 performed as per current standard immunohistochemical assay in a Clinical Laboratory Improvement Amendments (CLIA)-approved laboratory.
  • Eastern Cooperative Oncology Group (ECOG) 0-1.
  • Body weight must be > 30 Kg.
  • Hemoglobin > 8 g/dL.
  • Absolute neutrophil count (ANC) > 1,200 x 10^9/mL.
  • Platelet count > 75 x 10^9/mL.
  • Serum bilirubin =< 1.5 x institutional upper limit of normal (ULN) OR direct bilirubin =< ULN if total bilirubin levels > 1.5 x ULN.
  • Aspartate aminotransferase (AST/serum glutamic oxaloacetic transaminase [SGOT]) and alanine aminotransferase (ALT/serum glutamate-pyruvate transaminase [SGPT]) =< 5 x ULN.
  • Prothrombin time (PT) and partial thromboplastin time (PTT) < 1.5 x the ULN.
  • Serum creatinine =< 1.5 x ULN OR measured creatinine clearance (CL) > 40 mL/min or calculated creatinine clearance CL > 40 mL/min by the Cockcroft-Gault formula 8 or by 24- hour urine collection for determination of creatinine clearance.
  • Palliative radiation therapy is allowed to non-target lesions at the discretion of the treating physician.
  • Patients must have measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded) or evaluable disease as outlined in Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1.
  • Life expectancy of greater than 3 months in the opinion of the treating physician.
  • Female patients of childbearing potential must have a negative serum pregnancy test within 7 days prior to enrollment.

Exclusion Criteria:

  • Prior exposure to the IRX-2 regimen and/or PD-1/PD-L1 inhibitors are excluded.
  • Radiation therapy with a curable intent within 30 days of first dose of study treatment is excluded. However, radiation therapy with a palliative intent is allowed as long as treatment with study medication occurs >= 14 days after the last dose of radiation.
  • Any medical contraindications or previous therapy that would preclude treatment with the IRX-2 regimen or pembrolizumab.
  • Known allergies to ciprofloxacin or phytohemagglutin given trace amount of these agents are contained in IRX-2.
  • Patients with ongoing chronic myelosuppression, myelodysplasia, or hemorrhagic cystitis which would contraindicate receipt of cyclophosphamide.
  • Any unresolved toxicity National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) grade >= 2 from previous anticancer therapy with the exception of alopecia, vitiligo, and the laboratory values defined in the inclusion criteria.
  • Patients with grade >= 2 neuropathy will be evaluated on a case-by-case basis after consultation with the study physician.
  • Patients with irreversible toxicity not reasonably expected to be exacerbated by treatment with IRX-2, pembrolizumab may be included only after consultation with the study physician.
  • Active or prior documented autoimmune or inflammatory disorders (including inflammatory bowel disease [e.g., colitis or Crohn's disease], diverticulitis [with the exception of diverticulosis], systemic lupus erythematosus, Sarcoidosis syndrome, or Wegener syndrome [granulomatosis with polyangiitis, Graves' disease, rheumatoid arthritis, hypophysitis, uveitis, etc]). The following are exceptions to this criterion:

    • Patients with vitiligo or alopecia.
    • Patients with hypothyroidism (e.g., following Hashimoto syndrome) stable on hormone replacement.
    • Any chronic skin condition that does not require systemic therapy.
    • Patients without active disease in the last 2 years may be included but only after consultation with the study physician.
    • Patients with celiac disease controlled by diet alone.
  • Current or prior use of immunosuppressive medication within 14 days prior to cycle 1, day 1. The following are exceptions to this criterion:

    • Intranasal, inhaled, topical steroid or local steroid injections (e.g., intra articular injection).
    • Systemic corticosteroids at physiologic doses not to exceed 10 mg/day of prednisone or its equivalent.
    • Steroids as premedication for hypersensitivity reactions (e.g., computed tomography [CT] scan premedication).
  • Major surgical procedure (as defined by the Investigator) within 28 days prior to cycle 1, day 1. Note: Local surgery of isolated lesions for palliative intent is acceptable.
  • History of allogeneic organ transplantation.
  • Symptomatic cardiopulmonary disease (including congestive heart failure and hypertension), coronary artery disease, serious arrhythmia or chronic lung disease. Patients with these conditions who are stable with relatively minor symptoms and who are appropriate candidates for systemic treatments need not be excluded.
  • Myocardial infarction within the last 3 months.
  • Has a known history of human immunodeficiency virus (HIV) (HIV 1/2 antibodies).
  • Has a history of active hepatitis B requiring ongoing antiviral therapy or a history of untreated hepatitis C.
  • Has received a live vaccine within 4 months of planned start of study therapy (cycle 1, day 1).

    • Note: The killed virus vaccines used for seasonal influenza vaccines for injection are allowed provided not within 4 weeks of planned start of study therapy (cycle 1, day 1); however intranasal influenza vaccines (e.g., FluMist) are live attenuated vaccines and are not allowed.
  • Signs or symptoms of systemic infection (use of antibiotics to treat superficial infection or contamination of tumor shall not, by itself, be considered evidence of infection).
  • Stroke or other symptoms of cerebral vascular insufficiency within the last 3 months.
  • Previous diagnosis of invasive cancer from which the individual is not disease-free AND that has required treatment within the past 3 years, except for superficial skin, cervical cancer in-situ, or early stage prostate or bladder cancer (i.e. treatment with curative intent and long term disease-free expectations).
  • History of leptomeningeal carcinomatosis.
  • Known allergy or hypersensitivity to any of the study drugs or any of the study drug excipients.
  • Female patients who are pregnant or breastfeeding or male or female patients of reproductive potential who are not willing to employ effective birth control from screening to one year after last dose of cyclophosphamide or 180 days after the last dose of pembrolizumab therapy, whichever is longer.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03918499


Locations
Layout table for location information
United States, California
City of Hope Medical Center Recruiting
Duarte, California, United States, 91010
Contact: Joseph Chao, MD    626-218-3494    jchao@coh.org   
Principal Investigator: Joseph Chao, MD         
United States, Texas
Texas Oncology at Baylor Charles A Sammons Cancer Center Not yet recruiting
Dallas, Texas, United States, 75246
Contact: Andrew S. Paulson    214-370-1000    acott.paulson@usoncology.com   
Principal Investigator: Andrew S. Paulson         
Sponsors and Collaborators
City of Hope Medical Center
National Cancer Institute (NCI)
Investigators
Layout table for investigator information
Principal Investigator: Joseph Chao, MD City of Hope Medical Center

Layout table for additonal information
Responsible Party: City of Hope Medical Center
ClinicalTrials.gov Identifier: NCT03918499     History of Changes
Other Study ID Numbers: 18069
NCI-2018-01885 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) )
18069 ( Other Identifier: City of Hope Medical Center )
First Posted: April 17, 2019    Key Record Dates
Last Update Posted: May 15, 2019
Last Verified: May 2019

Layout table for additional information
Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No

Additional relevant MeSH terms:
Layout table for MeSH terms
Esophageal Neoplasms
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Neoplasms
Gastrointestinal Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Head and Neck Neoplasms
Esophageal Diseases
Adenocarcinoma
Carcinoma
Digestive System Diseases
Gastrointestinal Diseases
Pembrolizumab
Antineoplastic Agents, Immunological
Antineoplastic Agents